Not so funny turns

A nna was referred at the age of 7 years to a paediatric cardiologist. She had a history of “funny turns” comprising dizzy spells and syncopes. The symptoms had been going on for several years. There was no clear precipitating factor but sometimes they occurred during exercise or with a fright. She would usually have a prodrome of dizziness before losing consciousness but she denied palpitations. The symptoms seemed to occur more often at school. Anna’s mother gave an example where Anna had complained of feeling dizzy while swimming, had then become unresponsive for about 30 s and was disorientated for 30 min thereafter. Occasionally on losing consciousness, Anna would be incontinent of urine and have twitching movements. There were no tonic clonic seizures or focal neurological symptoms. Anna was otherwise healthy with no medical history of note and was taking no regular drugs. There was no family history of syncope, sudden death or deafness. A 12-lead ECG showed sinus rhythm with a normal QTc (fig 1). Figure 1  12-lead ECG in sinus rhythm showing normal QTc. More than 25% of children will have an episode of syncope during childhood.1 There are many causes of childhood syncope (table 1). The most common cause is benign neurocardiogenic (vasovagal) syncope, which occurs because of a transient disturbance in the autonomic control of heart rate and blood pressure. A few childhood syncopes are due to a potentially more serious cause. A precise history is the key to the diagnosis, with regard for warning signs that may point towards a more serious cause (table 2). View this table: Table 1  Causes of syncope in childhood View this table: Table 2  Warning signs from the history Clinical examination was unremarkable apart from a soft systolic murmur. A 12-lead ECG showed sinus rhythm, with normal QRS axis, normal P waves, normal PR interval and no pre-excitation. There …